Acetabular Fossa, Femoral Fovea, and the Ligamentum Teres

Ligamentum teres and acetabular cotyloid fossa pathology may be underappreciated as important causes of nonarthritic hip pain and mechanical symptoms. Tears of the ligamentum teres, stenosis of the cotyloid fossa, and disorders such as synovial chondromatosis represent three of the most common pathologic findings in this area of the acetabulum. The ligamentum teres has been recognized as a static stabilizer of the hip that plays a role in force distribution and can also be a pain generator. In those patients with symptomatic instability and both subjective and positive clinical exam findings who have failed prior surgical procedures and lack dysplasia, ligamentum teres reconstruction using varying techniques and graft sources have been performed. While an uncommon and benign condition, the cartilaginous loose bodies of synovial chondromatosis can lead to chondral damage secondary to mechanical abrasion from the loose bodies. Arthroscopic removal of the loose bodies and synovectomy have shown satisfactory results with minimal postoperative rehabilitation required. A stenotic cotyloid fossa secondary to heterotopic bone formation or abnormal amounts of fibrous and fatty tissue deposition can incarcerate the ligamentum teres and exert a space-occupying effect. This can lead to lateral subluxation of the femoral head with subsequent chondrolabral junction ramifications. The goal of treatment is removing any space-occupying tissue from the fossa to decompress the ligamentum and perhaps improve joint congruence.